Korean J Hematol.  2005 Mar;40(1):1-7. 10.5045/kjh.2005.40.1.1.

Clinical Features of Hospitalized Adults with Infectious Mononucleosis

• Kim JH
• Jang HJ
• Yoon HY
• Lee SI
• Kwon JH
• Jung JY
• Kim HJ
• Song HH
• Lee KS
• Zang DY
• Ahn JS
• Park YI

• KMID: 2252359
• DOI: http://doi.org/10.5045/kjh.2005.40.1.1

Abstract

BACKGROUND
Infectious mononucleosis (IM) is typically caused by Epstein-Barr virus (EBV), but can also be caused by drugs and other pathogens, such as cytomegalovirus (CMV) and hepatitis B virus. It shows a wide range of clinical and laboratory characteristics, which are presumed to be dependent on the patient age during the primary infection. This report describes the clinical features of hospitalized adults who developed EBV- or CMV-induced IM.
METHODS
The medical records of adult patients, diagnosed as EBV- or CMV-induced IM at the Hallym Medical Center and Dankook University Hospital, between January 1999 and July 2004, were retrospectively reviewed.
RESULTS
The analysis included 23 patients, consisting of 16 with EBV-induced IM and 7 with CMV- induced IM. Many of these patients were hospitalized under the impressions of either acute pharyngitis, acute hepatitis, fever of unknown origin or a malignant lymphoma. The vast majority of patients initially demonstrated lymphocytosis, with atypical lymphocytes. While patients younger than 20 years of age, usually presented with the classic triad of symptoms; IM-fever, pharyngitis and lymphadenopathy; those over the age of 20 often presented without pharyngitis or lymphadenopathy. There were no significant differences in the laboratory findings between EBV- and CMI-induced IM. Compared with patients with EBV-induced IM, however, those with CMV-induced IM were more likely to have abdominal pain (12.5% vs. 57%, P=0.04) and nausea or vomiting (25% vs. 75%, P=0.07), but less likely to have pharyngitis (69% vs. 14%, P=0.03) and cervical lymphadenopathy (75% vs. 14%, P=0.01).
CONCLUSION
IM in adults, especially in those above 20 years of age or if induced by CMV, are characterized by the atypical clinical manifestations. A higher index of suspicion and more attention must be paid to reduce unnecessary diagnostic work-ups and management.

Keyword

Epstein-Barr virus; Cytomegalovirus; Infectious mononucleosis

MeSH Terms

Abdominal Pain
Adult*
Cytomegalovirus
Fever of Unknown Origin
Hepatitis
Hepatitis B virus
Herpesvirus 4, Human
Humans
Infectious Mononucleosis*
Lymphatic Diseases
Lymphocytes
Lymphocytosis
Lymphoma
Medical Records
Nausea
Pharyngitis
Retrospective Studies
Vomiting

Reference

1). Hickey SM, Strasburger VC. What every pediatrician should know about infectious mononucleosis in adolescents. Pediatr Clin North Am. 1997; 44:1541–56.

2). Sumaya CV, Ench Y. Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings. Pediartrics. 1985; 75:1003–10.

3). Pereira MS, Blake JM, Macrae AD. EB virus antibody at different ages. Br Med J. 1969; 4:526–67.

4). Borer A, Gilad J, Haikin H, Riesenberg K, Porath A, Schlaeffer F. Clinical features and costs of care for hospitalized adults with primary Epstein-Barr virus infection. Am J Med. 1999; 107:44–8.

5). Heath CW Jr, Brodsky AL, Potolski AI. Infectious mononucleosis in a general population. Am J Epidemiol. 1972; 95:46–52.

6). Choi JS, Kim TH, Park HY, Lim SC. Clinical analysis of infectious mononucleosis. Korean J Otolaryngol. 1997; 40:914–21.

7). Horwitz CA, Henle W, Henle G, et al. Heterophil-negative infectious mononucleosis and mononucleosis-like illnesses. Laboratory confirmation of 43 cases. Am J Med. 1977; 63:947–57.

8). Kato T, Ichihara K, Terada K, Matsuda N. Multivariate analysis of the associations between laboratory data and clinical features among patients with infectious mononucleosis syndrome. Rinsho Byori. 1998; 46:1056–60.

9). Taga K, Taga H, Tosato G. Diagnosis of atypical cases of infectious mononucleosis. Clin Infect Dis. 2001; 33:83–8.

10). Sprunt TP, Evans FA. Mononuclear leukocytosis in reaction to acute infections (infectious mononucleosis). Johns Hopkins Med J. 1923; 374:410.

11). Evans AS, Niederman JC, McCollum RW. Seroepidemiologic studies of infectious mononucleosis with EB virus. N Engl J Med. 1968; 279:1121–7.

12). Fleisher G, Hinle W, Hinle G, Lennette ET, Biggar RJ. Primary infection with Epstein-Barr virus in infants in the United States: Clinical and serological observations. J Infect Dis. 1979; 139:553–8.

13). Oh SH, Lee YA, Moon WY, et al. Prevalence of Epstein-Barr virus (EBV) antibody in Korean children. J Korean Pediatr. 1994; 34:804–11.

14). Horwitz CA, Henle W, Henle G, et al. Clinical and laboratory evaluation of cytomegalovirus-induced mononucleosis in previously healthy individuals. Report of 82 cases. Medicine. 1986; 65:124–34.

15). Rodriguez-Bano J, Muniain MA, Borobio MV, et al. Cytomegalovirus mononucleosis as a cause of prolonged fever and prominent weight loss in immunocompetent adults. Clin Microbiol Infect. 2004; 10:468–70.

16). Klemola E, Kaariainen L. Cytomegalovirus as a possible cause of a disease resembling infectious mononucleosis. Br Med J. 1965; 2:1099–102.

17). Betts RF. Syndromes of cytomegalovirus infection. Adv Intern Med. 1980; 26:447–66.

18). Begovac J, Soldo I, Presecki V. Cytomegalovirus mononucleosis in children compared with the infection in adults and Epstein-Barr virus mononucleosis. J Infect. 1988; 17:121–5.